Express Scripts adding Humira biosimilars to formulary

Photo: Jeff Lagasse/Healthcare Finance News

Pharmacy benefit manager Express Scripts, part of Cigna's Evernorth subsidiary, will be adding Humira biosimilars to its formulary in 2023 as preferred products, which will be available to patients with inflammatory conditions.

A number of biosimilar therapies clinically equivalent to Humira are expected to become available next year, all approved by the Food and Drug Administration and with no clinically meaningful differences in safety and efficacy, according to a statement from Evernorth. 

The company expects these equivalent therapies will help to drive down healthcare costs and give patients and providers more choice and flexibility.

"Lack of competition allows sky-high prescription drug prices," said Harold Carter, chief pharma trade relations officer for Express Scripts. "We can generate more competition in the inflammatory drug class by adding biosimilars to our largest formularies in the coming months."

WHAT'S THE IMPACT?

According to Express Scripts trend data, specialty medications drive half of total drug spending, despite being used by less than 2% of the population. That's because until recently inflammatory medications have had little to no competition. With that market edge, manufacturers were able to set high launch prices and hike prices annually.

The company said that it's using preferred formulary placement as a tool to help plans encourage the use of more cost-effective products, including certain biosimilars, instead of higher-cost alternatives. For example, Express Scripts added Semglee, the first FDA-approved interchangeable biosimilar basal insulin, to the National Preferred Formulary (NPF) this year.

In doing so, the company estimates more than $20 million savings for plan sponsors in one year.

By 2024, Express Scripts expects biosimilars for inflammatory conditions to create market competition with the biologics that represent nearly half of current spending on conditions like rheumatoid arthritis.

In the coming months, the company will continue to evaluate all biosimilar products to Humira for placement on its largest formularies and will provide updates related to specific changes.

THE LARGER TREND

Express Scripts, which had been taken to a Massachusetts court for allegedly overcharging for some injured workers' prescriptions, settled the case for $3.2 million last month.

The case had been brought by the state's Attorney General's Office, which alleged that Express Scripts billed and was paid for prescription drugs from payers of workers' compensation claims in amounts that exceeded what is outlined in state law.

"These alleged overcharges occurred on prescription drugs provided by pharmacies to workers' compensation insurance beneficiaries who utilized CVS, Walgreens, Rite Aid and other pharmacies in various MA locations such as: Springfield, Boston, Fall River, and Worcester," according to the court document.

ON THE RECORD

"By adding biosimilars at the preferred status in the coming months, we can provide options in this complex and dynamic market," said Carter. "As always, we will remain nimble and continue negotiating with drug manufacturers to help patients and plans achieve lower costs for their medications. It takes market competition to drive down drug prices long-term, and it requires close care coordination to support patients starting a new medicine. We are uniquely positioned to do both – and in the process, support access to these safe, effective medicines for those we serve."
 

Twitter: @JELagasse
Email the writer: Jeff.Lagasse@himssmedia.com